Invited Review Article
Rescue of Retinal Function by Macular Translocation Surgery in Age-Related Macular Degeneration and Other Diseases with Subfoveal Choroidal Neovascularization
HIROKO TERASAKI
pg(s) 1- 9
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Age-related macular degeneration (AMD) is the leading cause of legal blindness among the elderly. In AMD and some other macular diseases, subfoveal choroidal neovascularization (CNV) damages the underlying retinal pigment epithelium (RPE), and because retinal function is dependent on a healthy RPE, vision is markedly reduced by a subfoveal CNV.
To treat such CNVs, macular translocation surgery has been performed to move the sensory retina from the damaged RPE to healthier RPE. At present, this surgery is the only possible treatment to improve the visual acuity of patients with subfoveal CNV.
Macular translocation surgery involves the detachment of the entire retina from the RPE by a subretinal infusion of fluid and creating a 360° circumferential retinotomy followed by the rotation of the retina. Severe postoperative complications such as recurrent retinal detachment have been reported in about 30% of the cases after macular translocation.
To determine the efficacy of this surgery, it is necessary to demonstrate an improvement in macular and overall retinal function objectively as well as subjectively. To this end, we have assessed the changes in visual function by measuring the visual acuity subjectively, and the macular function objectively by focal macular ERGs (FERGs). We shall show that there is an improvement in the FERGs in most patients after retinal translocation surgery but the full-field ERGs were reduced by about 30%. Thus, macular translocation surgery with 360-degree retinotomy may be feasible for macular function, although some degree of peripheral retinal function is lost.
Review Article
Human Herpesvirus 6 Infection in Transplantation
TETSUSHI YOSHIKAWA
pg(s) 11- 18
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Human herpesvirus 6 (HHV-6) is ubiquitous in the human population and causes exanthem subitum, a benign disease seen in infancy. The virus remains latent in the body after primary infection, and reactivates in immunocompromised patients. Infection occurs in nearly half of all bone marrow or solid organ transplant recipients 2–3 weeks following the procedure. It has been suggested that the viral infection and activation result in clinical symptoms including fever, skin rash, pneumonia, bone marrow suppression, encephalitis, and rejection. In order to control the viral infection, several studies investigating the route of viral transmission and diagnostic procedures have been carried out.
Original Papers
Reizinduzierte und reizüberdauernde Phänomene bei Intermittierender Rhythmischer Fotostimulation (IPS) als Zeichen neuronaler Plastizität
RUDIGER RAU, CHRISTOPH RASCHKA and HORST J. KOCH
pg(s) 19- 32
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Die Elektroenzephalogramme (EEG) und Visuell Evozierten Potentiale (VEP) von 30 gesunden Probanden wurden im Hinblick auf Modulationen und reizüberdauernde Veränderungen unter Verwendung intermittierender rhythmischer Fotostimulation (IPS) explorativ untersucht. Visuell Evozierte Potentiale wurden mit Blitzlicht einer LED-Brille induziert. In der EEG-Spektralanalyse wurden die Global-Field-Power-Werte (GFP) in Ruhe und unter Blitzlicht-Reizserien über jeweils 30s mit 5 Hz, 10 und 20 Hz verglichen mit den GFP-Daten unmittelbar im Anschluß an die IPS.
Photic Driving Effekte (PDE) mit hoher interindividueller Variabilität konnten bei allen Probanden beobachtet werden; hierbei waren die Reizantworten bei Stimulation mit 10 Hz, also im Bereich des spontanen Alpha-Rhythmus, am stärksten ausgeprägt. Im Durchschnitt führte IPS mit 10 und 20 Hz zu einem Anstieg der GFP-Werte in den entsprechenden Frequenzfenstern und den Bereichen der harmonischen Oberwellen. Im Zeitraum von 4 s nach IPS zeichnete sich eine signifikante Abnahme der GFP-Durchschnittswerte innerhalb des 10 Hz-Frequenzbandes ab. In der VEP-Analyse fand sich bei allen Probanden eine Steady-State-VEP-Antwort (STVEP) bei 10 Hz-Reizung. In der Hälfte der Fälle konnten reizüberdauernde Potentiale in den ersten 2 s nach IPS registriert werden. Die Differenzwerte zwischen GFP im 10 Hz-Band in Ruhe und unter 10 Hz-FS korrelierten (r= 0.56) mit den Amplitudenhöhen der VEP unter 10 Hz-Reizung. Die reizüberdauernden Phänomene werden im Rahmen von synaptischer Kurzzeit-Plastizität diskutiert.
Quantitative Estimation of Dietary Energy Deficiency and Effects of Its Supplementation on Protein Nutritional Status of Nondiabetic Uremic Patients Undergoing Protein Restricted Dietary Regimens
NORIHISA IWAYAMA, TORU SHINZATO, SHIGERU NAKAI, SHIZUE ANDO, YOSHIO NAGAKE, HIROFUMI MAKINO and KENJI MAEDA
pg(s) 33- 42
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In chronic renal failure (CRF) patients with a reduced protein intake, if the patients' energy intake could be estimated on the basis of biochemical data together with protein intake, it would be easier to provide them with adequate dietary treatment. Thus, from the relationship among the normalized protein catabolic rate (nPCR) and the intrinsic creatinine generation rate (%GCr) both calculated on the basis of 24-hr urine creatinine, as well as the daily dietary energy intake evaluated by a skilled nutritionist, we devised the following equation to estimate the amount of dietary energy deficiency (delta E) whose supplementation increases the %GCr of patients on protein-restricted dietary regimens to the target level (i.e., the dietary energy deficient amount). This was done by taking the %GCr of average nondiabetic hemodialysis patients of the same age and sex as a temporal target level: delta E = [31.22 - 1.97 (%GCr)0.6]/(nPCR)0.15. In order to examine the clinical usefulness of this equation, the daily dietary energy deficient amount calculated by the equation was supplemented with protein-free jelly. As a result, the %GCr increased from approximately three-fourths of the target level to the target level within 4 months.
Spatial Image of School Environment in Children with Cleft Lip and/or Palate
MASAYO KASUYA, YOSHIHIRO SAWAKI and MINORU UEDA
pg(s) 43- 49
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To evaluate the adaptability of children with cleft lip and/or palate to school, their mental images of the school environment were investigated in a semantic differential method survey using 23 pairs of adjectives. The following eight places on and off the school grounds were chosen as environmental factors; classroom, gymnasium, school nurse’s office, teachers’ office, playground, hallway, road leading to school and road leading back home. 50 children with cleft lip and/or palate (ages 10–11 years) were enrolled in this study. These children had a feeling of liberation in the teachers’ office and school nurse’s office. However, they did not have an established feeling of relaxation or affinity in the classroom, gymnasium, playground, hallway, or on the road to and from school, the very locales that were the main areas of their school activity. This suggested that self-expression and adaptation were difficult for these children.
Body Iron Stores and Iron Restoration Rate in Japanese Patients with Chronic Hepatitis C as Measured During Therapeutic Iron Removal Revealed Neither Increased Body Iron Stores nor Effects of C282Y and H63D Mutations on Iron Indices
YUHTA SHIONO, HISAO HAYASHI, SHINNYA WAKUSAWA, FUJIKO SANAE, TOSHIKUNI TAKIKAWA, MOTOYOSHI YANO, KENNTARO YOSHIOKA and HIROSHI SAITO
pg(s) 51- 57
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Information on the level of iron stores in chronic hepatitis C is clinically important because its reduction is technically simple and therapeutically effective. This study was performed to measure the levels of iron stores from the total amounts of hemoglobin removed during iron reduction therapy. The C282Y and H63D mutations of HFE gene were analyzed in 94 patients. All of the patients were negative for C282Y mutation. One patient was homozygous, and 4 patients were heterozygous for H63D mutation. The body iron stores and iron restoration rate were measured in 59 patients in serial courses of iron reduction therapy. Mean values of body iron stores in the two groups with and without H63D mutation were 890 and 606 mg, while those of iron restoration rate were 1.85 and 1.52 mg/day, respectively. None of the indices of iron metabolism were different from the reference values measured similarly in healthy subjects, suggesting that the iron deposition in chronic hepatitis C is limited to the liver, probably due to changes in the iron distribution in tissues.